"Where are my men?"

I know the purpose of this blog is to just keep y'all updated on the daily happenings of the Spencer family, so I guess this counts.

Last week was a short week, due to our holiday on Monday, but it felt like the longest week ever. It seemed to drag on and on, and then after Friday, I was just toast. Done. Worn out. Finished. I went home Friday afternoon, had a campout with the family on the couch, and spent the whole day Saturday in jammies, snuggling with the family and watching movies all day. Really. I almost grew tentacles like a slug. I was worn out, felt like I had been beaten by a baseball bat, don't really know what was wrong with me. Anyway, something happened with a patient on Friday that I can't stop thinking about so I guess I'll tell you guys about it. I will not give any identifying markers of this patient, but I have to give you a little background to understand it.

First of all, let me start by saying that I've seen a lot of shit during the last 6 years in the Navy, but thankfully, none of it was operational. The closest to the desert that I got was a beach in Hawaii. And my number was never pulled to deploy. If it had been, I would have gone without too much complaint (well, maybe some but you know me, if I didn't bitch about something I would blow up) because after all, that's kind of what I signed up for. Supporting the war on terrorism. More accurately, supporting the men and women who put their boots on the ground fighting the war on terrorism. And their families. But of all of those children, family members, and servicemembers I have treated, this guy is in my top 10 of people I will never forget.

As a Navy doc, it's my job to treat not only our sailors but our Marines as well. And I've loved it. After all, you'll never find a group of people more energized and motivated to do what they're asked to do. And this guy is no different. For the sake of argument, let's call him Logan. An active duty Marine who has done quite a bit of time in Iraq. Just like every other Marine, Logan was more than eager to tell me about his experiences in country, and give me details that I wasn't quite expecting.

I got to meet Logan because he had been referred to me as a dental fears patient. The first time I saw him, the only history I got was that ever since he had gotten back from Iraq, he hadn't been able to tolerate dental treatment. Something about sharp things in his mouth. I heard some fuzzy story about him pinning a dentist against the wall when he surprised Logan with something sharp. So I was already expecting a battle.

I went in the room and met a normal looking guy, well, normal for a Marine anyway. Average height and weight with classic flat-top "jarhead" Marine haircut. We shook hands and I sat down to talk with him. I cleared out the room of excessive people (he seemed to be more nervous with an audience, and I wanted to respect his privacy) and he gave me the background.

Logan had spent several months in Iraq a few years ago. His platoon saw some pretty heavy activity, many gunfights, IEDs, roadside bombs, field mines, you name it. Logan himself had been hit by a roadside bomb and suffered some trauma to his feet and shrapnel damage to his head. I saw some scars on his face and he explained where they came from. He said that he had seen several of his squad members die in front of his eyes and had been suffering from some pretty severe Post-Traumatic Stress Disorder since he had been home. The nightmares, flashbacks, and rage had torn apart his marriage (although they have since gotten back together and are in counseling together...I met her later, wonderful woman, but I'll get to that). He was currently in a recruiting office and in counseling and treatment for his PTSD. To deal with his rage, it is universally encouraged throughout the service (just found this out) that the member be involved with some sort of fighting sport. Logan was involved in extreme fighting (cage fighting? I'm not sure) to "get the rage out" as he put it. He told me that he was very sensitive about his feet and his head, and that anything unexpected was very hard for him to deal with.

Just as an aside: You don't have to be a pediatric dentist or even someone who has dealt with "dental fears" to understand that all this guy needed was some compassion, someone who would take their time and help him work through his dental fears, to go slow, to explain every step as they went along, and to not surprise him with anything. Easy. Right? Oh, no. Some dentists in the service (I hate to generalize, but that's really how it is, and not just in the military) become complacent. They treat patients like numbers, "treat 'em and street 'em", and tend to forget that there is a patient attached to that tooth. A patient with thoughts, feelings, and fears. A patient that has their individual issues, one that may be on the brink of snapping from stress. A patient just like Logan. It shouldn't take someone getting to the place where he was at for someone to take notice and start treating him like a human, instead of a head case. There are thousands upon thousands of soldiers, sailors and Marines out there just like him who just haven't reached that point yet. All it takes to make them snap in the dental chair is someone who DOESN'T take into account their history, their own set of conditions that makes that person human, to treat them like a tooth and boom, there you go. Breakdown. I hope that makes sense. What I'm trying to say is that if everyone took the time to treat their patients with just an ounce of compassion, it may never get to the point where Logan was at. There's no reason why anyone should have to bring out a special skill set to have to treat someone with anxiety, if they had a good bedside (chairside) manner to begin with, it should come naturally.

But I digress.

Logan had been treated once successfully under IV sedation for some minor dental work before, so that's what we decided to do this time. We gave him all the information, got some xrays, and signed some consents that day. He let me do an exam on him and we set an appointment to sedate him and finish his work in a couple of weeks.


Flash forward to this past Friday.

Logan showed up with his wife (his safe driver) for the procedure. The IV was started without incident, and we began the procedure. We sedated him enough for me to take out one tooth, but when I tried to start the fillings, that's when we had trouble. Logan was having trouble staying in a good sedated place, because he was having some sleep apnea type symptoms and would startle himself "awake" every few seconds, and then his head would jerk, his arms and legs would move, and we couldn't safely continue the procedure with him moving. We made the decision to stop, wake him up, and try something else at a later date, like an O.R. visit or something else. It was just simply not safe to sedate him heavily enough in our office setting for me to get the work done, no big deal, it happens, so we made the decision to abort the procedure and let him wake up as the medication wore off.

And that's when it started.

As Logan began to come to, I started trying to wake him up and help him come around. I kept asking him to open his eyes and tell him where he was and what was going on. As I was speaking to him, this is what happened:

Logan: "Shh. Shhhh!"

Me: "What?"

Logan: "Shhhh. Gunfire. Gunfire!"

Pause.

Longer pause.

Me: "Logan, there's no gunfire, you're in the dental office. You just had some work done and you're waking up."

Logan: "Where's my men?"

Me: "They're safe, Logan. You're home. Everybody's home. You're in Great Lakes. You're in the dental office. You just had work done and you're waking up."

Chills ran down my spine as I realized Logan was having some wicked flashbacks. His fists came up and he began jerking in the chair. I thought at first it was a seizure but then I quickly realized he was acting out something (which he later told me he thought he was running a 50 cal machine gun off the back of a tank)

This continued for nearly an hour. He kept waking up, indicating that he knew where he was, and then would fall back into a deeper plane of anesthesia, saying things like,

"Did Davis make it?"

"Have you seen Christenson?" (names changed to protect identity)

"Where are my men?" again, and again.

At one point, when I thought he had woken up enough, I asked,

"Logan, where are you?"

"Al-Assad," he answered.

Chills, again. I felt so terrible that he was reliving these moments as I desperately tried to wake him up. One of my wonderful assistants had been holding his hands this entire time, and he kept trying to shoot a gun with one of them. She looked absolutely shocked, and I knew she must be feeling as terrible for him as I was, but I just kept going.

Finally, FINALLY, he seemed lucid enough, so we brought in his wonderful wife. Upon seeing her, he immediately broke into tears. She sat down next to him and started rubbing his earlobes, which seemed to have a calming effect. (Isn't it amazing how we know our spouses so well that we know their trigger zones to calm down? I love seeing that kind of closeness in a couple, it makes me feel warm to know that he had that kind of support). Logan mumbled something to his wife, and she said, "You know he's not here, baby." She seemed to be very familiar with this behavior.

Later, after Logan was completely lucid, we talked some more. He told me that of his platoon, there were 280 wounded and 32 dead. He had seen his best friend completely eviscerated in front of his eyes. I asked him how he had slept the previous night (thinking that a lack of sleep had brought these flashbacks on). Logan looked at me with sleepy eyes and said, "Doc, I don't sleep. I don't want to. The nightmares are too bad."

His wife told me that this happens to him EVERY NIGHT. She has to help him come back to reality, to remind him where he is, to tell him again that he's home, and that those people he was asking for didn't make it.

Imagine that. Mom, Dad, I know you don't have to, that you've been there.

But these young people who come back from the war like this are as crippled as those who come back missing limbs. Thank God that we're now more educated and able to help them, but still, it will be years before this man sleeps through the night peacefully, if ever.

So for now, I just ask that you keep "Logan" in your prayers. I can't give his real name for privacy purposes but you could pray for Jodie's PTSD patient and his family.



I'm sure God will figure it out.